Aorto-left ventricular tunnel arising from the left coronary sinus of valsalva

Aortico-left ventricular tunnel is a rare congenital cardiac defect that bypasses the aortic valve via a para-valvular connection from the left ventricle to aorta. In most cases, the tunnel arises from the right aortic sinus. In this case report, we present a case of Aortico-left ventricular tunnel, in which the aortic orifice arose from the left aortic sinus, requiring special attention to avoid injuring the left coronary artery at the time of surgical repair.

Mid-term results of the lateral tunnel operation at Queen Alia heart institute

To determine midterm results of univentricular repair using intra-atrial lateral tunnel at Queen Alia Heart Institute. Between January 1999 and January 2005, 159 patients [99 males, 60 females] underwent either a fenestrated or non-fenestrated lateral tunnel [Fontan procedure], for a wide range of complex congenital heart disease with a functional single ventricle at Queen Alia Heart Institute. Median age at operation time was 3.8 years [range 1.5-17 years]. Multiple factors were analyzed including: anatomical variations, mean right atrial pressure, pulmonary artery pressure, ventricular end diastolic pressure, aortic saturation, cardiopulmonary bypass time and ischemic time, presence of arrhythmias, pacemaker insertion, thromboembolic complications, early and late mortality. The major anatomic diagnosis was double inlet left ventricle in 72 patients [45.3%] and the least was unbalanced complete atrioventricular septal defect among 8 patients [5%]. Dextrocardia was found in 17 patients. The mean right atrial pressure was 8 +/- 3 mmHg, pulmonary artery pressure 13 +/- 2.6 mmHg, PVR 1.9 +/- 2 Woodunits.m2, ventricular end diastolic pressure 14 +/- 2.2 mmHg, aortic saturation 83 +/- 4%, cardiopulmonary bypass time 121 +/- 9 minutes, ischemic time 47 +/- 3 minutes. Early postoperative supraventricular tachyarrhythmia [SVT] occurred among 10 cases [6.3%] of patients, in whom four needed antiarrhythmic drugs before discharge. Early bradyarrhythmia needing pacemaker in 2 patients [1.26%], whereas 6 patients needed pacemaker at mid term follow-up. There were 10 [6.3%] early deaths and no late deaths occurred after 6 years of follow-up. Seven [4.7%] patients developed protein loosing enteropathy as a late complication and 7 more patients [4.7%] developed neurological complications. Proper selection of patients for the lateral tunnel Fontan procedure results in excellent early and mid-term survival and functional outcome with low incidence of complications